In the last years significant progress has been made in the management of patients with pancreatic head cancer. The incidence of adenocarcinoma of the pancreas has been increasing world-wide in recent years, and it is currently the fourth leading cause of cancer-related mortality. Surgical resection offers a low success rate but provides the only chance of cure. Surgery ideally includes a radical (R0) resection and reestablishment of gastrointestinal continuity. A pancreatico-duodenectomy is usually surgical technique and only curative procedure. Contraindications for curative resection are the presence of distant metastases, peritoneal seeding and extension of tumour. Tumour infiltrations into mesenteric and portal vein are relative contraindications. The most important prognostic factors in radical resections has been shown to be surgically negative margins and nodal status. Systemic chemotherapy, radiation or a combination of chemotherapy and radiation have all been used either prior to resection (neoadjuvant therapy) or following surgical resection (adjuvant therapy) in an effort to improve the cure rate achieved with surgery alone.